Healthcare Provider Details

I. General information

NPI: 1124942644
Provider Name (Legal Business Name): ANASTASIA NIKEATRA ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

196 PARKWAY CIR STE 4
WEST MONROE LA
71292-8057
US

IV. Provider business mailing address

196 PARKWAY CIR STE 4
WEST MONROE LA
71292-8057
US

V. Phone/Fax

Practice location:
  • Phone: 318-728-8006
  • Fax: 318-575-4054
Mailing address:
  • Phone: 318-728-8006
  • Fax: 318-575-4054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberCIT-6181
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: